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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000358

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Robie OnleySymonds Sex Male

Date of Birth March 2, 1921 Place of Birth Clarks HarbourCounty of Shelburne

Name of Father Frank Symonds MAIDEN NAME of Mother Laura Mildred Duncan

Residence of Father when child was born Clarks Harbour, Shelburne Co., NS Present address of Father Clarks Harbour, Shelburne Co., NS

Occupation of Father at Birth of child Fisherman Place of birth of Father Clarks Harbour, Shelburne Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Frank Symonds Address of Applicant Clarks Harbour, Shelburne Co., NS Date 24 April 1942

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Robie OnleySymonds

Born at Clarks Harbour in the County of Shelburne

That Robie OnleySymonds Whose Birth is sought to be registered was

born at Clarks Harbour Shelburne County on March 2, 1921

My knowledge of the fact and date of such Birth is based on the following Circumstances:

I am his mother

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